Have I mentioned recently what a great team of medical advisors is associated with MiddlesexMD? We regularly draw from the wisdom and experience of leaders in the field of aging and sexuality. In the next two posts, we’ll hear from Dr. Susan Kellogg, who is not only one of our esteemed advisors, but who also co-founded and directs the Pelvic and Sexual Health Institute in Philadelphia. Read on as Dr. Susan shares with us some of the barriers to sexuality for older women. And thanks, Susan!

In my practice I regularly see women in their 60s and 70s. What often impresses me is how unique each is in her experience of sexuality.

Some still like sex and remain sexually active, while others just aren’t interested—even if they have a functional partner.

Of course, there’s been a lot of research, mostly on the age-related changes men experience. I think this is because male sexuality is more straightforward. With women, as has been said elsewhere on MiddlesexMD, it’s complicated.

So, let’s look at some of the impediments to sexuality for women as they age.

Internalized ageism. We absorb cultural messages all our lives. They bombard us from the media, from religion, maybe from the region we live in or the ethnic group we belong to. The messages can be subtle (“Good girls don’t…”) or they can be in-your-face (“You’ve come a long way, Baby.”)

While the messages have shifted over the years, some are inconsistent and some remain the same. For example, one consistent message is that “real” men remain sexually active as they age. (Which, I’m thinking, can be pretty tough on men, too.) For example, an older man’s ability to attract (and, presumably, to satisfy) the “trophy” wife is a status symbol synonymous with wealth, virility, and power. The messages are mixed for older women. It’s desirable to be a “cougar” in your 40s and 50s, but the ground shifts subtly after that. Despite the sexual older woman portrayed by the Golden Girls, or by Diane Keaton in Something’s Gotta Give, or Meryl Streep in Mamma Mia, the word on the street is that we older women ought to settle gracefully into our roles as the sexless Grandma. A foxy granny just doesn’t play well.

We, in turn, can be very sensitive to these cultural expectations, and we can allow them to define us. We can internalize them.

In fact, research suggests that gay men and heterosexual women are highly susceptible to internalizing cultural messages that equate aging with loss of interest in sex.

When we implicitly assent to the message that we’re old and therefore no longer sexually attractive or viable, it can affect our self-esteem and our experience of sex and intimacy. The message is false, and believing it is a shame.

Sexual scripts from families-of-origin. Just like societal messages, we absorb beliefs and assumptions about sex from our families. They can be deeply imprinted on our young minds, and they don’t have to be clear or verbalized. In fact, our families are often the first place we learned about sex.

Did our parents smooch and cuddle or were they cold and distant? Did sex seem natural and loving or was it something shameful and dirty? Did the sex stop at some point? Did they move to separate beds or separate bedrooms? Did this seem to be expected at a certain age?

Women commonly internalize direct and indirect messages about aging and sexuality from family members. Usually, we’re not even aware of it.

Low self esteem. It’s hard enough to maintain a strong sense of self-worth in this world without the added insult of getting old in a culture that absolutely idolizes youth and beauty.

We may have survived the adolescent jungle and our family of origin with, I hope, few scars. Many of us have struggled with self-esteem, and that struggle has only changed, not ended.

Now we’re hit with an entirely new challenge: how to maintain our confidence and positive self-image as we grow old in a culture that seems to have no use for us simply because we’re not young.

It’s unfair and it’s insulting, and it takes a strong sense of self to stand against that bias.

Unfortunately, for some women, feelings of low self-worth become an impediment to sex. I think this is why some women complain about feeling unattractive and losing desire. It’s hard to feel sexy when you feel dowdy and useless.

One client even said that when she saw her sagging breasts in the mirror she felt that she did not “deserve to have sex.”

The truth is, of course, that beauty has a lot more to do with confidence and creativity than with perfectly taut skin. Cover up the mirrors. Be proud of your wrinkles! You’ve earned them. To be continued…